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UNDERGROII TANK PROGRAM OFFICIAL INSf 'TION REPORT <br />SAN JOAQUIN HEALTH DISTRICI- <br />1601 E. HAZELTON AVE. <br />COUNTY NAME <br />46 <br />OCA 95205 <br />PHONNEE NNO. 468-3423 <br />PO. <br />COUNTY # <br />SITE NAME: 110HAI A <br />�n <br />7y <br />INSPECTION DATE: <br />SITE ADDRESS: S <br />54 <br />CITY/STATE/ZIPf/AON <br />74W--7 S7jD� <br />CHANGES SITE/OWNER/PERMIT? YES <br />FORM A AND/OR B SUBMITTED? <br />TYPE FINSPE TION SITE COMPUTER # <br />20� <br />O <br />TANK TANK <br />COMPUTE O COMPUTEfo0� <br />NUMBER d NUMBER / <br />PER # PER # E <br />EXP. DAT EXP. DATE <br />TANK TANK <br />COMPUTER COMPUTER <br />NUMBER NUMBER <br />PER # PER # <br />EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />TANK CONTENTS <br />M1WOR MINOR=•,::a: _ <br />1 2 <br />34 <br />5 6 <br />7 8 <br />9 110 <br />11 112 <br />13 114 1_ <br />15 16 <br />17 <br />19 120 1- <br />21 22 <br />23 124 <br />2526 <br />_. <br />27 28 <br />29 30 <br />31 32 <br />_ <br />33 34 <br />._.. <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL W3839FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />IEMOVAL OF RESIDUAL MATERIALS <br />1PING <br />LAMMABLE VAPORS REMOVED <br />INAUTHORIZED RELEASE <br />AMPUNG <br />APROPER ABANDONMENT <br />46 <br />47 <br />48 <br />49 <br />50 <br />51 <br />52 <br />53 <br />54 <br />55 <br />56 <br />!STEM STATUS (MUST MARK ONE) <br />MAJOR 57MINOR 58 <br />VIOL LiVIOL ❑ <br />59 <br />NO j' <br />VIOL JQI <br />INSP: <br />TITLE: <br />NUT -3 <br />THE MARKED ITEMS <br />ORIGINAL <br />m <br />AND MUST BE COR TED AS <br />